IGAP Flap Breast Reconstruction
As with the SGAP Flap procedure, IGAP Flap (Inferior Gluteal Artery Perforator Flap), is ideal for women who do not have an adequate amount of excess abdominal tissue to donate for breast reconstruction, or for those who would prefer to use the lower buttock as a donor site.
You are an ideal candidate if you:
- Prefer the most realistic breast shape and texture
- Wish to utilize their own body tissue rather than implants
- Do not have enough abdominal fat to create a matching breast
- Have scars on their abdomen
- Are a NON-smoker
- Have had a previous implant reconstruction procedure with unsatisfactory results
Almost all patients are candidates for use of the lower buttock (the IGAP) for breast reconstruction. As it is a free flap, advanced microsurgical techniques are used to meticulously separate the tiny blood vessels that supply the skin and fat from the gluteal muscle while preserving muscular integrity. Once the flap is transferred to the chest, these tiny blood vessels of the IGAP flap are connected to existing blood vessels either at the side of the breastbone or in the armpit.
When the blood vessels of the flap are connected and the flap is seen to be receiving a good blood supply through the new channels, the skin and fat of the IGAP flap are shaped to form the new breast mound and the wounds are closed, generally with dissolving sutures. Whenever possible, a sensory nerve in the IGAP flap is connected to a sensory nerve at the mastectomy site to help maximize return of sensation in the reconstructed breast.
Because no muscle is cut or removed, there is almost no risk of weakness or herniation. There is a small risk of damage to the sciatic nerve, which passes close to the gluteal muscles, but injury to this is rare as it is clearly identified and avoided during the early part of the operation. With the IGAP flap, larger breast sizes may be created, and the scar easily hidden by underwear because it is in the buttock crease. One disadvantage would be that removing fat from one buttock will lead to a degree of asymmetry of the buttocks. A second operation may be required to perform a buttock lift on the non-operated side to achieve symmetry.
The procedure generally takes anywhere from six to eight hours to complete, and is performed under general anaesthesia. It is lengthy due to the precise nature of this microsurgical procedure. However, the surgical effort is rewarded by excellent cosmetic results. The procedure is also less invasive, resulting in less pain and faster recovery.
Although IGAP flaps can be used for bilateral breast reconstruction, it is recommended that only one side is operated at a time, since each side requires around six to eight hours. In general there should be about 6 weeks between the two operations.
A few months after the breast reconstruction procedure, if it was removed with mastectomy, restoration of the nipple and areola will follow. The shape of the breast may also be refined to be more symmetrical with your untreated breast. For many patients the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.
- Most realistic breast texture and skin colour match
- No breast implants used for reconstruction
- Short reconstructive process – wake up with the breast mound in place
- Fewer long-term complications and re-operations
- Reconstruction can tolerate radiotherapy
- No abdominal scarring or weakness
- No loss of muscle strength
- Buttock scar is hidden by underwear
- Provides skin to replace the nipple area in immediate reconstruction to allow only a single, circular breast scar around the nipple
- Long anaesthetic time
- Uncomfortable recovery
- Asymmetrical buttocks
- Repositioning during surgery
- May need further small procedures to re-shape breast
- Potential for injury to sciatic nerve
- Sitting can be uncomfortable for a few months after surgery
Risks & Complications
All patients must understand and accept that no surgical procedure is absolutely free from risk. For further information concerning the risks and complications associated with Autologous Breast Reconstruction, please refer to Risks and Complications of utologous Breast Reconstruction.